A Blueprint for Success, Effectively Negotiating Third Party Physician Payer Agreements

This program comprised of 4 individual course modules, spanning a period of four weeks, is designed to teach students the skills to negotiate fair reimbursement from third-party payers and to employ useful tools which can effectively monitor payments to ensure contract compliance and also to provide data for future negotiations. This course includes online reading assignments, WebEx-type lectures and workshops plus a four-month license to utilize the contract monitoring software, HealthcentsRevolution™ software, developed by Healthcents.

Whether it is with a major commercial insurance plan, a Medicare Advantage plan or an independent provider association, enhanced contract negotiation skills will generate healthy returns for urology practices. With the increasing emphasis on the concept of accountable care organizations (ACOs), urology practices will also be negotiating contracts with their primary care colleagues who have formed ACOs as well as fee-for-service contracts with their regular payers. This training will prepare you for this new negotiation effort and will enhance your value to your employer. This training will provide a flexible schedule for students to carry out some of the assignments so they can work at their own pace. The WebEx events will be prescheduled but the reading assignments and projects will be self-paced with deadlines for completion. See the detailed program agenda for each of the four course modules below.

This education is designed by Susan Charkin, the CEO of Healthcents, an expert in the field with experience negotiating from the payer side and also the provider side. She is an experienced instructor who is passionate about helping her clients and her students be successful in negotiating fair contracts for payment.

"I feel like I have sufficient tools to negotiate when our biggest payer responds again. Thanks for everything you have done. I really appreciate having a slice of your knowledge. "

Kyle Watson, participant in Class 3Practice Manager
Florida

"Contract negotiation is a very timely issue. Rather than assume that nothing can be done with insurance contracts, all managers will benefit from this course and the tools that they give you to help in the process of contract negotiation. The worksheets and software were great; I have done a couple of contract negotiations before but this course gave me a chance to understand it better."

Regina Bash, RN, participant in Class 1 Practice Manager
Pennsylvania

"I love that we will finally have the same information that the insurance companies have."

What third party payors "don't want you to know"
(methods to mitigate/address these areas)

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How revenues flow from payers to practices

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Reimbursement issues: is 3rd party payer contracting right for me?

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Are you better off being in-network or out of network?

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What payers are looking for and how they are regulated

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What is necessary for provider empowerment?

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How you can leverage PPO licensure and accreditation

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Overall negotiation strategies

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Justifications for renegotiations and payment adjustments

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How to use HealthcentsRevolution™ Software
(Out of Network and Claims Analyzer models)

Course Module #2 – Data Acquisition for the Proposal Letter

Objectives – Prepare an overall negotiation strategy with justifications. Perform a reimbursement and language analysis of a PPO/Third party payer agreement. Change the agreement and what to specifically ask for. Reimbursement statistical modeling and how to evaluate payer proposals and develop counterproposals with high dollar return on investment.

Agenda

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Analyzing and understanding the uniqueness of your Practice

Market penetration of other urologists

Unique/special services only performed by your Practice

Local physician referral patterns in your area

Are you the only provider in a 25 mile radius? Or, are there many urologists in a 5 mile radius?

Percentage of total business from 3rd party payors
(commercial PPO/third party payors + Medicare)

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Maximizing your reimbursement

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Detecting problematic rates and language issues

Course Module #3 – Reimbursement Analysis

Objectives – Using the HealthcentsRevolution™ In Network / Out of Network model – determine the breakeven point. When is it worthwhilsoftware, understand the range of analytics that can be performed and the types of "what if" which are easily addressed by this powerful software tool.

Agenda

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Use of the Revolution® software

In Network / Out of Network model – determine the breakeven point. When is it worthwhile to go out of network?

How do your charges compare to others (benchmark data)

Evaluate what other similar providers are charging third party payors.

How does your payer reimbursement compare?

Give your payor the top 40 codes and ask to see how your group's current reimbursement compares to Medicare

Student Exercises – what to look out for in a third party payor agreement

Participants will demonstrate competence in detecting problem areas in agreements – what type of language and rates to negotiate "in" and "out" of agreements. This will be a demonstration/Individual exercise.

Use AMA contracts template in locating key information in the contract (Lecture/Demonstration/Individual exercise)

Actual use of the HealthcentsRevolution™ software tool. Effectively review a third party payer agreement for rates and language (2-3 samples).

Course Module #4 – Preparing the Proposal Letter and Negotiation Tips

Objectives – Preparing and sending a Proposal Letter. Understand what PPOs and third party payers "don't want physician practices to know" and specific methods for addressing and mitigating. What to do when you get pushback for the payer. How to "sell the physician" to the payer. And, finalizing negotiations and how to close out.

Agenda

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Utilizing data analysis and preparing the proposal letter

Template proposal letters

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How to "sell the physician" – most third party payer negotiators get between 30-40 calls a day from providers wanting to join their networks. How do you get to the top of the list to negotiate or re-negotiate an agreement?

The mystery of contacting a third party payor

Getting to the right person/department

Getting a call back from the contractor

Completing you negotiations in record time (A "How'to" Guide)

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Getting to "Yes" – What to say when you get "pushback" from third party payors

Payors will state that they have different departments for hospital, ancillary and physician contracts and don't have the budget for your increase

Payors will say that they cannot give us the rates as our competition offers lower rates than we do and the payor will drive additional business to our competition if we don't sign up for the rates that they want

Payors will say that if you are non-contracting, patients will choose in-network providers because they are cheaper

Payors will tell you if you don't contract that they will send the payments to the patients

Students will be given the tools to know how to navigate these types of scenarios